Want evidence of systemic racism? Look to public health

Deeming racism a public health crisis was a new approach to acknowledging systemic inequities and obstacles in 2020, but within public health research and advocacy, racism’s broad and devastating impact on Black Americans has long been well-recognized.

No health disparities are quite as profound as those between Blacks and whites, shows decades of research across ages, ethnicities, sexual orientations and socioeconomic statuses. Compared to whites, Black Americans receive less overall health care and have a lower life expectancy, more than double the rate of infant mortality and higher death rates from a multitude of health threats, including pregnancy-related complications, cancer, homicide and COVID-19.

Now that many U.S. states, counties and cities have declared racism a public health crisis, it’s important to realize that lasting solutions will require vast societal change at both the cultural and institutional levels, said Tasleem Padamsee, assistant professor of health services management and policy at Ohio State’s College of Public Health.

“Black Americans and other people of color are subject to so many additional stressors, resource limitations and external constraints that all of these things turn up way downstream in their health outcomes,” Padamsee said. “And that is a result of the many different ways that race is structured into our society.”

When it comes to common contributors to poor health like poverty, unemployment, less education and pollution exposure, Black Americans consistently bear disproportionate burdens. So it’s unfortunately no surprise that Padamsee’s research is uncovering more racial health disparities among women at high risk for breast cancer, she said.

Understanding how high-risk women make decisions about genetic testing, prevention and early detection is a newer area of study, Padamsee said. Her work comes at a time when women and doctors have — in theory — access to more prevention information, improved testing and early, effective treatments. But she’s found that Black American women face more challenges than white women in managing breast cancer risk, both in information gathering and insurance coverage for tests and procedures. Black women are 40% more likely to die from breast cancer than white women, despite similar diagnosis rates.

“These are all fundamental injustices in policy and health care that stem from how the whole society is structured to advantage certain groups over others,” Padamsee said. “We don’t always have to know where our research will go or what the policy impact will be, but if we can identify where we’re falling down, we can recommend change.”

 Health disparities between Blacks and whites are actually wider at higher income levels, according to research led by sociology professor Cynthia Colen, who also has an appointment in the College of Public Health.

Institutional restructuring and academic research help in the fight to dismantle racism, but small actions count too, Padamsee said. People can spur change through educating themselves, participating in social activism or even something as little as having a conversation, because all of these can build together to put pressure on those in power, she said.

“We need to keep changing people’s hearts, minds, behaviors, policies and actions,” Padamsee said.

That pressing need has been recognized within the college, as Dean Amy Fairchild and other college leaders have explored how to improve as a college. Following the killings of Eric Garner, Ahmaud Arbery, Breonna Taylor, George Floyd and other Black Americans, leaders at the College of Public Health began to re-examine curriculums and hiring processes, bolster efforts to educate faculty and staff and take a hard look at how they could better listen to, support and recruit Black students, staff and faculty.

Since last summer, the college’s Executive and Diversity, Equity and Inclusive Excellence Committees have held regular forums and listening sessions for students of color, and launched a Community of Inclusion certificate for faculty and staff, which dozens are pursuing. The college has introduced new scholarships for students with diverse backgrounds and life experiences and begun the process of ensuring equity and inclusion are built into every public health course, as well as every employment decision.

“I believe that diversity is excellence. This is a time in our history to grow as a college by closely examining everything we do and finding ways to strengthen our commitment to build systems that support and sustain inclusive excellence at the institutional level and help to dismantle systems that create structural barriers to equity at the societal level,” Dean Fairchild said. “This is also a time to bolster the outstanding work our faculty are already doing to better understand racism’s grasp on public health in America and to dismantle health inequities brought on by racism.” 

For example, JaNelle Ricks, assistant professor of health behavior and health promotion and an expert in sexual and reproductive health disparities, examines how societal factors coalesce to affect health outcomes. She recently led a study that found Black men who had been incarcerated reported recent sexual behaviors more risky than those who had never been in jail. Black men are much more likely to be incarcerated than white men. They’re also at higher risk for HIV/AIDS and other STDs.

For Ricks, racism is a lot about power. 

“The bottom line is that the majority group has the power and they’re wielding that power for their benefit against other minority groups, who are suffering in many different ways,” Ricks said, adding she has hope for the current uprising. “In the past we’ve seen cycles of protesting, but that gets quelled, and we go back to the status quo or see some incremental change over time. I would love to see enough people being moved by the latest fires to actually make some radical change.”

Other attempts to untangle the complex, cumulative effects of oppressive societal systems on health are underway at the Social Epidemiology to Eliminate Disparities lab, led by Assistant Professor of Epidemiology Shawnita Sealy-Jefferson. Here, researchers are seeking solutions to the disproportionate infant mortality rate among Black women — which is especially pronounced in Columbus. 

The first social epidemiologist at Ohio State, Sealy-Jefferson joined the college in 2018 and quickly established an undergraduate course in social epidemiology examining how the distribution of advantages and disadvantages in society reflect the distribution of health and disease.

“In public health we have a moral imperative to fight for social justice,” Sealy-Jefferson said.